healing Billing Terms and healing Coding Terminology

Aarp Medicare Supplement Insurance Plans - healing Billing Terms and healing Coding Terminology

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Those in curative billing and coding careers have a terminology of unique terms and abbreviations. Below are some of the more frequently used curative Billing terms and acronyms. Also included is some curative coding terminology.

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Aarp Medicare Supplement Insurance Plans

Aging - Refers to the unpaid guarnatee claims or inpatient balances that are due past 30 days. Most curative billing software's have the capability to create a separate record for guarnatee aging and inpatient aging. These reports typically list balances by 30, 60, 90, and 120 day increments.

Appeal - When an guarnatee plan does not pay for treatment, an request for retrial (either by the victualer or patient) is the process of formally objecting this judgment. The insurer may require added documentation.

Applied to Deductible - Typically seen on the inpatient statement. This is the number of the charges, considered by the patients guarnatee plan, the inpatient owes the provider. Many plans have a maximum each year deductible that once met is then covered by the guarnatee provider.

Assignment of Benefits - guarnatee payments that are paid to the doctor or hospital for a patients treatment.

Beneficiary  - man or persons covered by the health guarnatee plan.

Clearinghouse - This is a aid that transmits claims to guarnatee carriers. Prior to submitting claims the clearinghouse scrubs claims and checks for errors. This minimizes the number of rejected claims as most errors can be surely corrected. Clearinghouses electronically transmit claim information that is compliant with the definite Hippa standards (this is one of the curative billing terms we see a lot more of lately).

Cms - Centers for Medicaid and Medicare Services. Federal group which administers Medicare, Medicaid, Hippa, and other health programs. Once known as the Hcfa (Health Care Financing Administration). You'll observation that Cms it the source of a lot of curative billing terms.

Cms 1500 - curative claim form established by Cms to submit paper claims to Medicare and Medicaid. Most industrial guarnatee carriers also require paper claims be submitted on Cms-1500's. The form is great by it's red ink.

Coding -Medical Billing Coding involves taking the doctors notes from a inpatient visit and translating them into the permissible Icd-9 code for pathology and Cpt codes for treatment.

Co-Insurance - division or number defined in the guarnatee plan for which the inpatient is responsible. Most plans have a ratio of 90/10 or 80/20, 70/30, etc. For example the guarnatee carrier pays 80% and the inpatient pays 20%.

Co-Pay - number paid by inpatient at each visit as defined by the insured plan.

Cpt Code - Current Procedural Terminology. This is a 5 digit code assigned for reporting a policy performed by the physician. The Cpt has a corresponding Icd-9 pathology code. Established by the American curative Association. This is one of the curative billing terms we use a lot.

Date of aid (Dos) - Date that health care services were provided.

Day Sheet - summary of daily inpatient treatments, charges, and payments received.

Deductible - number inpatient must pay before guarnatee coverage begins. For example, a inpatient could have a 00 deductible per year before their health guarnatee will begin paying. This could take some doctor's visits or prescriptions to reach the deductible.

Demographics - corporeal characteristics of a inpatient such as age, sex, address, etc. Vital for filing a claim.

Dme - Durable curative tool - curative supplies such as wheelchairs, oxygen, catheter, glucose monitors, crutches, walkers, etc.

Dob - Abbreviation for Date of Birth

Dx - Abbreviation for pathology code (Icd-9-Cm).

Electronic Claim - Claim information is sent electronically from the billing software to the clearinghouse or directly to the guarnatee carrier. The claim file must be in a suitable electronic format as defined by the receiver.

E/M - estimation and management section of the Cpt codes. These are the Cpt codes 99201 thru 99499 most used by physicians to way (or evaluate) a patients treatment needs.

Emr - Electronic curative Records. curative records in digital format of a patients hospital or victualer treatment.

Eob - Explanation of Benefits. One of the curative billing terms for the statement that comes with the guarnatee company payment to the victualer explaining payment details, covered charges, write offs, and inpatient responsibilities and deductibles.

Era - Electronic Remittance Advice. This is an electronic version of an guarnatee Eob that provides details of guarnatee claim payments. These are formatted in agreeing to the Hipaa X12N 835 standard.

Fee schedule - Cost linked with each treatment Cpt curative billing codes.

Fraud - When a victualer receives payment or a inpatient obtains services by deliberate, dishonest, or misleading means.

Guarantor - A responsible party and/or insured party who is not a patient.

Hcpcs - health Care Financing management tasteless policy Coding System. (pronounced "hick-picks"). This is a three level ideas of codes. Cpt is Level I. A standardized curative coding ideas used to recap exact items or services provided when delivering health services. May also be referred to as a policy code in the curative billing glossary.

The three Hcpcs levels are:

Level I - American curative Associations Current Procedural Terminology (Cpt) codes.

Level Ii - The alphanumeric codes which comprise mostly non-physician items or services such as curative supplies, ambulatory services, prosthesis, etc. These are items and services not covered by Cpt (Level I) procedures.

Level Iii - Local codes used by state Medicaid organizations, Medicare contractors, and incommunicable insurers for exact areas or programs.

Hipaa - health guarnatee Portability and accountability Act. some federal regulations intended to heighten the efficiency and effectiveness of health care. Hipaa has introduced a lot of new curative billing terms into our vocabulary lately.

Hmo - health Maintenance Organization. A type of health care plan that places restrictions on treatments.

Icd-9 Code - Also know as Icd-9-Cm. International Classification of Diseases classification ideas used to assign codes to inpatient diagnosis. This is a 3 to 5 digit number.

Icd 10 Code - 10th correction of the International Classification of Diseases. Uses 3 to 7 digit. Includes added digits to allow more available codes. The U.S. group of health and Human Services has set an implementation deadline of October, 2013 for Icd-10.

Inpatient - Hospital stay longer than one day (24 hours).

Maximum Out of Pocket - The maximum number the insured is responsible for paying for eligible health plan expenses. When this maximum limit is reached, the guarnatee typically then pays 100% of eligible expenses.

Medical Assistant - Performs administrative and clinical duties to retain a health care victualer such as a physician, physicians assistant, nurse, or nurse practitioner.

Medical Coder - Analyzes inpatient charts and assigns the definite Icd-9 pathology codes (soon to be Icd-10) and corresponding Cpt treatment codes and any linked Cpt modifiers.

Medical Billing devotee - The man who processes guarnatee claims and inpatient payments of services performed by a doctor or other health care victualer and vital to the financial performance of a practice. Makes sure curative billing codes and guarnatee information are entered correctly and submitted to guarnatee payer. Enters guarnatee payment information and processes inpatient statements and payments.

Medical Necessity - curative aid or policy performed for treatment of an illness or injury not considered investigational, cosmetic, or experimental.

Medical Transcription - The conversion of voice recorded or hand written curative information dictated by health care professionals (such as physicians) into text format records. These records can be whether electronic or paper.

Medicare - guarnatee provided by federal government for people over 65 or people under 65 with determined restrictions. Medicare has 2 parts; Medicare Part A for hospital coverage and Part B for doctors office or inpatient care.

Medicare Donut Hole - The gap or variation between the first limits of guarnatee and the catastrophic Medicare Part D coverage limits for prescription drugs.

Medicaid - guarnatee coverage for low earnings patients. Funded by Federal and state government and administered by states.

Modifier - Modifier to a Cpt treatment code that provide added information to guarnatee payers for procedures or services that have been altered or "modified" in some way. Modifiers are prominent to account for added procedures and collect repayment for them.

Network victualer - health care victualer who is contracted with an guarnatee victualer to provide care at a negotiated cost.

Npi number - National victualer Identifier. A unique 10 digit identification number required by Hipaa and assigned through the National Plan and victualer Enumeration ideas (Nppes).

Out-of Network (or Non-Participating) - A victualer that does not have a contract with the guarnatee carrier. Patients normally responsible for a greater portion of the charges or may have to pay all the charges for using an out-of network provider.

Out-Of-Pocket Maximum - The maximum number the inpatient is responsible to pay under their insurance. Charges above this limit are the guarnatee companies obligation. These Out-of-pocket maximums can apply to all coverage or to a exact benefit category such as prescriptions.

Outpatient - Typically treatment in a physicians office, clinic, or day surgery facility chronic less than one day.

Patient accountability - The number a inpatient is responsible for paying that is not covered by the guarnatee plan.

Pcp - former Care doctor - normally the doctor who provides first care and coordinates added care if necessary.

Ppo - favorite victualer Organization. guarnatee plan that allows the inpatient to plump a doctor or hospital within the network. Similar to an Hmo.

Practice management Software - software used for the daily operations of a providers office. Typically includes appointment scheduling and billing functions.

Preauthorization - Requirement of guarnatee plan for former care doctor to forewarn the inpatient guarnatee carrier of determined curative procedures (such as inpatient surgery) for those procedures to be considered a covered expense.

Premium - The number the insured or their owner pays (usually monthly) to the health guarnatee company for coverage.

Provider - doctor or curative care facility (hospital) that provides health care services.

Referral - When a victualer (typically the former Care Physician) refers a inpatient to other victualer (usually a specialist).

Self Pay - payment made at the time of aid by the patient.

Secondary guarnatee Claim - guarnatee claim for coverage paid after former guarnatee makes payment. Typically intended to cover gaps in guarnatee coverage.

Sof - Signature on File.

Superbill - One of the curative billing terms for the form the victualer uses to document the treatment and pathology for a inpatient visit. Typically includes some commonly used Icd-9 pathology and Cpt procedural codes. One of the most frequently used curative billing terms.

Supplemental guarnatee - added guarnatee policy that covers claims fro deductibles and coinsurance. frequently used to cover these expenses not covered by Medicare.

Taxonomy Code - Code for the victualer specialty sometimes required to process a claim.

Tertiary guarnatee - guarnatee paid in expanding to former and secondary insurance. Tertiary guarnatee covers costs the former and secondary guarnatee may not cover.

Tin - Tax Identification Number. Also known as owner Identification number (Ein).

Tos - Type of Service. record of the category of aid performed.

Ub04 - Claim form for hospitals, clinics, or any victualer billing for facility fees similar to Cms 1500. Replaces the Ub92 form.

Unbundling - Submitting more than one Cpt treatment code when only one is appropriate.

Upin - Unique doctor Identification Number. 6 digit doctor identification number created by Cms. Discontinued in 2007 and substituted by Npi number.

Write-off (W/O) - The variation between what the victualer charges for a policy or treatment and what the guarnatee plan allows. The inpatient is not responsible for the write off amount. May also be referred to as "not covered" in some glossary of billing terms.

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